Broken Ankle/Hospitalisation - my experience

Discussion in 'Vietnam - General Discussion Forum' started by Rod Page, Mar 19, 2012.

  1. Rod Page

    Rod Page Ol'Timer

    Many who read this forum would be aware that I recently broke an ankle in a 'planned' slide from a motorbike. This post is supplied in an endeavour to assist anyone else facing a similar misfortune whilst travelling in Vietnam.



    If you are involved in a serious accident in Vietnam you must call the police - experience shows that this will normally be done by a passer-by or someone else involved in the accident. The police will impound you bike (or car) until they complete their report (which basically means that all matters associated with the accident are settled - that you will not be suing any Vietnamese involved in the accident & that have met any expenses 'due to them' arising out of the accident. Be aware you will normally be expected to pay any Vietnamese suffering damage in the accident, irrespective of who's at fault, a nominal amount to cover any likely hospital costs or vehicle repair costs.).

    To secure the release of your bike you'll be required to furnish the police with an attestation translated into Vietnamese detailing the accident, what claims if any you intend making against any third party, that you'll meet your own costs concerning any charges resulting from the accident and, need I add, thanking the police for their professionalism & assistance!



    I was taken by ambulance to Vinh Hospital some 20kms south of the accident site - the ambulance fee was 800,000vnd. There was a general surgeon on duty. None of the medical staff spoke english (this is a major problem to consider before travelling). In a conference call between myself, the surgeon & my agent - having an agent is the best, if not essential (see below) way through the language issue - it was decided that I should take an ambulance to Viet Duc hospital in Hanoi almost 300kms north. Admission charges to Vinh Hospital amounted to 1,100,100vnd & the charge for the ambulance to Hanoi was 3,500,000vnd.

    Viet Duc is regarded as the best orthopedic hospital in Vietnam. Viet Duc is a teaching hospital linked to the university medical school - I find this the most effective way to reassure oneself as to 'the best hospital' in case of doubt. Clean, though not glamourous; there's a certain pragmatic practicality to the hospital, typical in Vietnam where there's neither a comprehensive health insurance scheme (due in 2014) nor 'medical tourism'.

    The ambulance staff took me to casualty then departed. An early challenge is that when you are moved from a sufficiently long ambulance stretcher to the beds used in admission, you'll find if you are tall (I'm almost 194cm) that your legs hang over at one end & your head at the other - its not a good position to be in with a broken ankle! Fortunately I was later moved to a bed of sufficient length.

    Your admission is totally in your own hands & this is a matter on which you should be clear. Vietnamese patients are always accompanied by members of their family who attend to ALL administrative issues at the hospital; administrative issues necessary to be admitted. In the absence of your having this support around you, the system & indeed all those in it will be confused, almost mesmorised in their inablity to assist you further. Staff will come to determine your basic condition but not to treat you (until you are admitted!) & the almost universal language problem sees you left waiting, as the hospital staff wait 'for your family to arrive' to have you admitted. Its an uneasy circle.

    My agent, Hang, came straight to the hospital, despite the hour, arriving around mid-night. The wisdom in having an agent is that the Vietnamese see such person as fulfilling the family role. Vietnam follows strictly a hierarchical structure - Vietnamese are loathe to make decisions on behalf of others, to have to take responsibility for those decisions. They will look to guidance from above & it continues upwardly endlessly! Having an agent made my admission move quickly.

    I had explained to Hang by phone that my daughter, Moana, had taken my passport & wallet following the accident but given the condition of the roads & the poor visibilty at night it had been decided that she & Dan would stay overnight in Ninh Binh. This is the next matter on which you should be totally clear - you will need identification & you will need to pay most charges in advance. I was extremely fortunate that Hang and her husband were able to pool the resources needed to see me admitted - 4,5000,000vnd, a considerable amount for a Vietnamese couple (remember the charge rate is considerably inflated for westerners seeking treatment).


    Most foreigners will be accommodated in casualty or the intensive care area; it is seen as a sign that the hospital is giving you their maximum attention! The abundance of doctors & staff on duty does not mean that things will progress as you may be anticipating. The hospital has a different anticipation - the anticipation that a family member will be there to make decisions on your behalf, be aware of hospital proceedures, know where to collect necessary paperwork & where to pay & gain the necessary receipt/s to ensure your treatment can proceed. This is an ever present problem if you are alone, unaware or unable to communicate.

    Following my admission & Hang returning home I would find myself isolated in casualty awaiting the arrival of my daughter - "the family" - the next day. It would be a long night. There was little contact from staff, no offer of pain killers (not that I felt I needed them or asked for them), no offer of food or water - this is why your family is there; they get you food & water, get you comfortable. The medical staff attend uniquely to your medical needs, the rest is up to your family. Anyone hospitalised should be acutely aware of this; it is anything but the typical western approach.

    I just wanted to sleep, but at 2am a doctor who spoke some english woke me up to a barrage of questions, before basically informing me that my case was not deemed as urgent & that maybe I'd like to move to another hospital to have the operation accelerated. With a change from the night to day staff at 6am I moved myself into a wheelchair & pushed my way into the doctor's area demanding that I speak to someone who could understand english. A 4th year medical student came forward. I explained that despite being admitted last night no-one had offered me any pain relief, that despite the hospital knowing that I had no family with me no-one had offered to get me a meal or something to drink & that at 2am a doctor had come to tell me my case was not deemed urgent & to consider another hospital. I said this was not the way to treat anyone, that if someone would simply explain 'the system' to me, explain what was required for my case to move forward I would comply so as to have my broken ankle attended to without further delay. I gleaned that as I had not paid (been unable until my daughter arrived) other than my admission fees (because I could not possibly know that they wanted x-ray fees, for example, paid in advance) they were concerned I might be determined not to pay at all & therefore looked to move me on.

    It worked wonders - the 4th year medical student came to apologise & went to buy me some food & drink. Shortly thereafter a team of orthopedic surgeons headed by a man who spoke excellent english arrived & presented to me my options - initially the administrative options & then my medical options. He was most impressive, very thorough in his analysis & diagnosis & I felt in good hands. I recall that when we had agreed to proceed, he then advised that permission to operate on a foreigner in the hospital would still required from the highest authorities. (You should be aware that hospitals in Vietnam require permission to admit & treat foreigners & few hospitals in Vietnam have such authorisation).

    I might add that it had become clear overnight that this was a hospital geared for work in the orthopedic area. There were a significant number of orthopedic surgeons on duty at all times, there were a number of x-ray facilities, areas for manipulation & rooms for the making of plaster casts. There was a clear sense of collegiality where surgeons would meet each morning & discuss the surgery ahead & every evening to discuss the operations performed that day. In the time I was in casualty I would have seen an average of ten people per hour admitted to hospital as the result of motorbike accidents & all requiring surgery.



    Moana & Dan would arrive, have the hospital proceedures explained & things would start to move forward immediately. Intrigueingly my doctor noticed that I held a French passport & I would find there were considerably more doctors who could speak french than english. Being able to communicate, needless to say, considerably improved matters.

    I was taken for X-rays. My orthopedic surgeon then advised that a manipulation would be undertaken at which time a further decision would be made concerning surgery (which he felt at the time would be likely).

    The manipulation merits detailing. I was taken to a room, placed on a far too short operating table covered in plaster & surrounded by several people in hospital attire none of whom spoke a word of english or french. I was terrified that the manipulation was about to be performed in the absence of any anaesthetic; no-one appeared to show any interest in what I had to say. Finally two needles were produced & I knew I'd been given a local anaesthetic. The 'manipulation team' waited several moments occasionally pinching my toes. There was a slight effect from the anaesthetic but my foot was anything but numb - it would appear they estimated my weight (although I dont believe they comprehend that tall westerners can weigh in excess of 100kl) then give you an added amount to that regularly given to locals. There's clearly no consideration of differing tolerance levels.

    Anyway, the moment had arrived. The doctor or maybe nurse who was to perform the manipulation took up his position at the base of my foot before a strongly built Vietnamese woman stood by my lower legs with 2 yellow straps that she would use to tie down my legs to ensure I could not move. (It toughens you up - big boys don't cry in the face of a woman, & you understand fully that women given their greater tolerance to pain will not flinch!)

    The proceedure is, well, painful, akin to torture really. Your leg is pulled down hard, bent backwards & forwards from the heel, your foot pressed upwards from the ball of the foot, all in an endeavour to improve the placement of the broken bones. The movements are repeated over & over again for a period I suppose of some 30 seconds to a minute. Vietnamese are known not to understand a westerners needs for space, for privacy & I'm told my yells saw a stream of people enter the room to observe.

    The proceedure over - yes you definitely do get the impression that these people perform these manipulations with great regularity & are excellent at their work - I headed for fresh x-rays. To be brief the x-rays indicated such a successful manipulation that it was deemed that an operation would not be required. Within 3 hours of my treatment starting it had finished & I was heading back to my hotel in plaster armed with the largest available crutches in Vietnam, yet still a full foot too short & about as useful as a pair of chopsticks!


    Charges for foreigners are far greater than those applied to locals - it would appear that the hospital may well just add another zero to the normal charge. My first set of x-rays cost 1,000,000vnd but the next were only 250,000vnd & the final x-rays 100,000vnd. I recall my second plaster applied after the first week cost 800,000vnd. All up the total medical costs associated with the accident were around $600 (but around a third of this was ambulance costs & a further third were admission charges).

    An extensive, fully detailed file is kept by the hospital but I was unable to get a copy despite several requests, despite advising it was required for insurance purposes for my own medical records or whatever. The surgeons would tell me that the hospital did not normally take in foreign patients & was therefore not geared to issue the paperwork required by insurance companies; that if the insurance company needed advice or information it should send the required forms to the hospital for completion. This potential outcome should be known to those travelling in advance.

    One intriguing sideline in having a leg in plaster is that when flying you are boarded onto airplanes via a special 'hospitalised' shoot driven to the back door of the plane to permit you to take your seat:

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  3. JB2112

    JB2112 Ol'Timer

    Thanks for taking the time to write this one up, Rod. Hope you heal quickly.
  4. bombdefuzer

    bombdefuzer Ol'Timer

    Get well soon Rod.
  5. Ian Bungy

    Ian Bungy Ol'Timer

    Sorry to hear You where injured and hope all goes well on Your recovery! Hell Mate a bit of a Scary Experience I say! I must admit Your style of Writing gave me some Great Laughs though!!! Wishing You Guys all the best!
  6. Rod Page

    Rod Page Ol'Timer

    Thanks for the well wishes fellas. All looks to be aok; we'll know more in a fortnight when the cast comes off.
    Bungy, not sure which parts made you laugh but I tell you the woman sent in to hold me down was like a Turkish wrestler; no way was there any option for me other than compliance.
  7. TonyBKK

    TonyBKK Ol'Timer

    Wow Rod!

    What a well written account of what had to be, at the time, a terrible experience!

    Considering how off they were with the local anesthetic how fortunate that you didn't have to undergo surgery!

    Wishing you a full and speedy recovery!

  8. DavidFL

    DavidFL Administrator Staff Member

    Bloody hell, what a report. I loved the manipulation treatment = ouch. I remember only too well my painful pickup ride in Laos with a crushed humerus head, bouncing around on the tray in the back.
    But it does sound as if you're in good hands & on the road to recovery.
    Get well soon & keep posting to relieve the boredom.
  9. Dougal

    Dougal Ol'Timer

    Great report Rod.

    Have been following your exploits with great interest and enjoyment.

    I worked just South of Vinh and sympathise totally with the 'communication' problems. Its almost unbelievable how few Vietnamese (outside the big cities) speak English.
    A friend of mine went seeking a doctor in a small town near Vinh (Ha Tinh) and we ended up with a dentist who sidelined as one of the local doctors !

    Wish you a speedy recovery and look forward to your next installment.
  10. schackster

    schackster Ol'Timer

    Rod, never a dull moment with you. Your report was enough to make me think twice about again riding in Vietnam. It was a real eye opener. Thank god you came out of it alright and I hope the injury heals quicker than the time it took to get some treatment. So what about the fate of your damaged bike ? Im guessing that will be a good reason for yet another report :)
    Take care Buddy ..
  11. Jurgen

    Jurgen Moderator

    Thank you Rod for this interesting (albeit chilling) report. We all hope that we will never have to follow your advises, but such things do not only happen to neighbors. It is, however, comforting to know that Asian doctors still have some crafts … to compensate lack of equipments. It is great that you avoided an operation. Best wishes for a fast healing.
  12. ronwebb

    ronwebb Ol'Timer

    Well, well ,well Rod. I don't know what else to say that hasn't already been posted, except to concur with Gary that there is never a dull moment with you around. I am wondering what the bride is making of all this from the beach on Tahaa?
  13. David Learmonth

    David Learmonth Ol'Timer

    Hope you recover soon! Reminds me a bit of my own experience in India just over 7 years ago. There at least the surgeon & nursing staff all spoke excellent English + I was with an Indian friend who was fluent in nearly all of the Indian languages anyway. Remember very well the surgeon pulling splinters of bone from my lower leg & drilling holes for the plate screws. Epidural - wouldn't give me general anaesthetic - too many patients woke up dead! That was in a private hospital in Jodphur.
  14. feejer

    feejer Ol'Timer

    Heal up soon Rod! And thanks to your sobering report, we have both purchased $1,000,000 in medical cover for our 3 weeks in VN through HCC. Only $77 so pretty foolish not to get covered at that price especially considering that includes the "sports rider" option for risky activities. And I will be bringing an ample supply of Oxycodone with me as it seems proper opiate analgesics are pretty scarce over there. Dihydrocodeine and Tramadol are pretty weak and no way do I want to be busted up and have nothing but that stuff for "relief". Here's hoping none of the above becomes necessary (fingers crossed!).
  15. Rod Page

    Rod Page Ol'Timer

    Thanks one & all for the replies & well wishes.

    The bike is fine (unlike its rider) with little to show for the skid. The hospital is actually well equipped but proven 'crafts' have not been disgarded - a positive worthy of some recognition, as others would have just proceeded straight to an operation. Judging by the experience of some others I have been quite fortunate. Feejer's lead for insurance is well timed in that HCC is a company that will insure older riders, a position that cover some in Thailand.

    The main point, however, of the post is its attempt to outline the proceedures one may well be faced with in the event of an accident. Having an understanding of what to expect, how it works in Vietnam is invaluable to anyone placed in the unfortunate position of needing to be in the hospital in the first place. As noted elsewhere in other reports of mine about travelling in this beautiful country one can sometimes be faced with a serious choice where the outcome may be hurtful; its not just a question of riding slowly (though that's where it should definitely start).

    Safe riding to all.
  16. Rod Page

    Rod Page Ol'Timer

    Hang, my agent, has recently contacted me to advise as follows:

    1. There are a published schedule of fees payable by non-Vietnamese using the hospital;

    2. Staffing levels are such that night-time medical staff are often required to determine cases in order of urgency for the following day's operations;

    3. Vietnamese culture dictates that decisions flow strictly from the top down; there is little room for discretion. Matters will proceed smoothly if the patient or a family member is able to take responsibility for the decisions that need to be taken.
  17. nikster

    nikster Ol'Timer

    Good story!

    Sounds like you've been unbelievably lucky with the medical care offered in Vietnam. No surgery is the best possible outcome for sure, and I don't know if the same had happened in another hospital, in Thailand or the west.
  18. Rod Page

    Rod Page Ol'Timer

    A quick post to wrap up the report.

    I'm just back from hospital in Da Nang where I had the plaster cast removed (now 6 weeks since the manipulation) & x-rays taken. The ortho said all is well, in fact an excellent result as was clear from the x-rays. With rehabilitation for the same amount of time the ankle was in plaster - 6 weeks - all should be as new.

    In summary I would have to agree whole-heartedly with nikster's comments in the post before this one; how good to see such an approach, such medical 'crafts' preserved in an operation mad world.

    I suppose its relevant to the report - the bill for the removal of the cast, x-rays & the specialist consultation came to 925,000vnd (around $45) & this was in the specially set-up section of the hospital set aside for foreigners.

    Thanks again to all for the concern.

    Safe riding.
  19. Rod Page

    Rod Page Ol'Timer

    I post the following article simply because health care is such an important issue to anyone travelling through Vietnam especially by motor-cycle.

    In the time I travelled the length & breadth of this beautiful country, travel which saw my having first hand experience at 2 hospitals - Da Lat & Viet Duc - I never once encountered 'bribery' of this nature nor even a suggestion from any member of the medical staff that some sort of 'payment' was required or encouraged.
  20. Rogdog

    Rogdog Member

    Wow... what can I add other than ouch!! Not yet needed to visit a Vietnamese hospital and have no desire to do so. However, as I have worked in Vietnam for four years, I do have the enviable position of having a large Vietnamese staff list to bug should I find myself in a similar situation. Anyone planning a ride in Vietnam is welcome to pm me for my contact info. I can always find help for a downed rider in need!
  21. VietHorse

    VietHorse Ol'Timer

    See this thread just now. Sorry for your incident, Rod.
    How are you now? How is the fracture now?
  22. Alex O

    Alex O Member

    i recently had a bike accident vietnam and i am lucky to be alive and have no really injurys but the question i have is how did u go with your insurance because as far as i had been told i was not really legally allowed to ride in vietnam. so does that mean issurane will not pay. pleasse if any one see's this help a brother out. thank u
  23. Rod Page

    Rod Page Ol'Timer

    On the advice of the Thai police & my lawyer in Chiang Mai we rode in Vietnam using Thai licences; on the basis that there was a reciprocal arrangement between certain SE Asian countries, including Thailand & Vietnam, involving the acceptance of each others licences. The concern, of course, was the application of the agreement in the face of any conflicting Vietnamese legislation - I have often been advised that one can not ride in Vietnam other than with a Vietnamese licence (but I will not go into the difficulties with obtaining such licence here).

    We also held the associated International Driving Permits, but here again there is the potential for dispute as in many countries one is required to take the licence of that country if residing in the said country for a continuous period of more than 3 months (something that may warrant consideration by many currently riding in Thailand).

    We were covered under the French healthcare system which differs significantly from others. In the case of claims presented from Da Lat hospital they were reimbursed without question. Viet Duc hospital is not authorised to take foreigners (I was accepted after special permission was obtained). When being discharged I was informed that as the hospital was not set-up to accept foreigners it did not prepare accounts in any particular format acceptable to foreign insurance companies. It would, however, make every endeavour to complete any forms that the insurance company may care to send them to permit any claim to proceed.

    In my case given my schedule upon leaving hospital, the amounts involved, other matters to attend to & my ultimately leaving Vietnam I did not find time to submit a claim for payment to my insurance company (but have no doubt that it would have been met).

    I know lawyers in Vietnam who can advise on the issue but given the speed with which the legislation in Vietnam can & does change, as does its application, & very much so, I feel the wiser approach is to seek written advice in advance from your insurance company as to how any claim would be met.
  24. Rod Page

    Rod Page Ol'Timer

    In an attempt to add further information in the hope of it being of assistance to anyone injured & seeking assistance in Vietnam I add the following update.

    Since returning to Australia I have continued my physio (at a large sports related clinic on the Gold Coast). The physios in Australia have confirmed (& were impressed by the fact) that the manipulation 'worked well'. Indeed they were intrigued to see the success, not to find a patient with screws in their joints. I find this a most interesting & important piece of information.

    The physio's here feel that the physio I was given in Vietnam, although basic was basically correct with the exception that they felt I had been encouraged FAR too early to walk & (worse) to walk on the soft sand. They felt that this had led to my favouring the broken leg, to my walking with the foot slightly turned out resulting in a 'potential', not actual, collapse of the foot's normal instep support system.

    All's well - I've been told to follow the golden rule of RICE - Rest Ice Compression Elevation - to wear supportive shoes (any of the 'Runners' are fine) & to follow a somewhat normal & well-known series of relatively simple exercises (internet covers this in case of need).

    Trust this helps anyone in need.
  25. DavidFL

    DavidFL Administrator Staff Member

    Good to know that "all is well" then & you're still recovering ok. Now to get you back to North Vietnam asap.....

    A comment
    Something too that I just noticed in Hanoi / Sapa - not as many pharmacies & no where as well stocked as in Thailand.
  26. Rod Page

    Rod Page Ol'Timer


    You are right David, & its good general information to have in a thread such as this.

    I found the best approach was to, where possible, head to the nearest hospital - they always have a pharmacy with correct pricing attached but there's usually someone on the hospital staff who can help with translations; invaluable when seeking specific medications.

    Looking forward to having your Sa Pa report.

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